After Hours Care Models - PMCT · After Hours Care Models The Royal Children’s Hospital Dr Jye...
Transcript of After Hours Care Models - PMCT · After Hours Care Models The Royal Children’s Hospital Dr Jye...
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After Hours Care Models
The Royal Children’s Hospital
Dr Jye Gard
Chief Resident Medical Officer, Junior Medical Staff Training & Support
After Hours Medical Lead, Short Stay Unit, General Medicine
Paediatric Clinical Teaching Fellow, University of Melbourne
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Contents
1. RCH after hours
2. Our JMS
3. Deciding to change
4. Changes and how
5. What we learnt
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Royal Children’s Hospital (RCH)
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RCH After Hours
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RCH After Hours
On floor 8:30am – 5:30pm After hours
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Our JMS
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• )
Our JMS
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• )
Our JMS
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Changes to RCH After Hours
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Changes to RCH After Hours• Nurse Hospital Manager
• Most senior person in the hospital after hours
• Operational decision maker: patient flow, code gray
responder, bed management, staffing allocations
• Clinical Nurse Consultant
• Senior nurse – ED nurse practitioner
• Can review unwell patients, transfer, proceduralist (site
IV, administer nitrous, venepuncture), assist JMS with
procedures, reviews
• Medical Lead
• Acute care trainee to coordinate workflow, provide
support, proactively identify and communicate risk,
develop anticipatory care plans
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Changes to RCH After Hours
1. Know your team:
• 2100 multidisciplinary handover
• 0100 multidisciplinary huddle
2. Communication:
• 24/7 use of electronic task board
3. Additional staffing:
• New Medical lead and Clinical Nurse Consultant roles
• Change in Social Worker hours in ED
• Extended Cardiology and Oncology resident hours
• Additional evening General Medicine registrar
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Outcomes so far
• Identification of patient of concern after hours a
(plan in place)
• Staff medical satisfaction and sense of team work
after hours
• Discharges after hours
• Time to admission from 1800 – 0800 and number
of General medicine admissions handed over to the
night team
• Cardiac and Oncology JMO overtime
• Unplanned admissions to PICU after hours
• MET calls after hours
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Outcomes so far
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Outcomes so far
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Outcomes so far
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Outcomes so far
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Lessons learnt
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Lessons learnt
• Difficulty navigating new roles
• Role vs. responsibility vs. expectations
• Integration within organisation
• Development of the after hours ‘team’
• Tensions with pre-existing teams
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Lessons learnt
1 The most effective tools were not
costly or particularly onerous
• Multidisciplinary handover and huddle
• Improved visibility of workloads
2 Workshop issues with all craft groups,
this includes the JMS
3 Models need to be tailored & creative
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Acknowledgements
• Paula Howard, RCH, Improvement Manager, Strategy and
Improvement
• Margot Nash, Director of Junior Medical Staff Training and
Support Unit, RCH
• Ed Oakley, Chief of Critical Care, RCH
• Bernadette O’Connor, Director of Allied Health, RCH
• Sheri Waldron, Director of Operations & Chief of Information
Nurse, RCH
• Tal Galdish, Intensive Care Unit Consultant, RCH
• Tom Connell, Director of General Medicine, RCH
• Georgina Tiller, General Medicine Fellow, RCH
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Questions?
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Outcomes so far
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After Hours Care
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Contents
1. RCH after hours
2. Our JMS
3. Deciding to change
4. Changes and how
5. What we learnt